EVALUATION OF ENURESIS BY A PEDIATRIC SURGEON

Purpose: Enuresis is defined as the involuntary discharge of urine after the age at which bladder control should have been established. Enuresis may be primary (child has never been dry), secondary (wetting follows a period of control), nocturnal, diurnal, complicated (UTI's or physical findings) or uncomplicated (no infections or physical findings). Enuresis may be the primary diagnosis or a symptom of some organic disorder. Virtually all cases of enuresis are evaluated initially by a primary care physician. Many cases, both complicated and uncomplicated, are subsequently referred to a pediatric surgeon or urologist. It has been suggested that patients with uncomplicated enuresis do not require evaluation beyond PE and urinalysis. On the contrary, our experience suggests that urologic studies (US & VCUG) in patients with uncomplicated enuresis will identify many unsuspected urinary tract abnormalities and alter therapy. Methods: Over a 36 month period we evaluated 27 consecutive patients who presented with a diagnosis of enuresis. We categorized each patient as complicated or uncomplicated. Of a total 27 patients, 18 (66%) were uncomplicated and 9 (33%) were complicated. Contrary to the usual recommended management. VCUG and US were requested on all uncomplicated patients. 16 of 18 patients underwent those studies. 2 patients cancelled. Results: Of 16 patients with uncomplicated enuresis who underwent US and VCUG, 12 (75%) were found to have some abnormality including: unilateral reflux (1), unilateral reflux with post void residual (1), unilateral reflux with duplicated system (1), small kidney/increased bladder size (1), urethral stricture (1), urethral valve (1), low capacity bladder/scar of kidney (1), lipoma of the cord (1), reflux into the vagina (1), post void residual (3). Our therapy was altered in 7 of 16 patients (44%). Conclusion: Most cases of uncomplicated enuresis in children are managed by primary care physicians, but many of these cases are referred to a pediatric surgeon or urologist. The current recommended evaluation of the uncomplicated enuretic child includes only PE and urinalysis. We have found that in patients referred to a pediatric surgeon, urologic evaluation of uncomplicated enuresis by VCUG and US will identify many unsuspected urologic abnormalities and change therapy in a significant number of patients.
Paul Brisson, M.D, Haroon Patei, M.D., Neil Feins, M.D. FAAP; Floating Hospital for Children. 750 Washington Street. Boston. MA [...]